Pediatric Coding Alert

Carol Jacobs, MD, FAAP, of Livingston, TX, was having problems getting reimbursed for otoacoustic emission cochlear evaluations for hearing screens. The codes for this are 92587 (limited) and 92588 (comprehensive or diagnostic). For this test, a probe, which emits a clicking sound that passes to the inner ear, is placed in the ear canal. The sound is picked up by the hair cells in the cochlea. The computer then records an echo off the hair cell. She uses this test on children under four years of age.

Children younger than four dont respond to pure-tone tests, she says. With older children, I do use pure tone and dont charge, as I was told it was part of the global fee. On younger children, however, Jacobs wants to bill for 92587, since thats what shes doing. And, she has found a way to get paid for the hearing test and the well-visit separately. She uses the modifier -25 (significant, separately identifiable service performed on the same day).

I invested in the machine, because the Texas legislature is going to require that all children be given this test, says Jacobs. She screens all patients. I give this test to a two-week-old, and to a two- or three-year-old who hasnt had the test yet, she explains. Instead of waiting until age four, studies have shown that its better to detect hearing problems early on, says Jacobs. Then more can be done in terms of intervention and treatment.

Jacobs adds the modifier -25 to the well-visit E/M code, and also uses CPT 92587 for the hearing evaluation. I am getting paid $47 by Medicaid, she says. If the child doesnt pass the test, she administers it again in a month.

Separate Diagnoses Not Required for -25 Modifier Usage

According to new CPT verbiage for modifier -25, you dont need separate diagnosis codes linked to the E/M code and the code for the hearing evaluation.

Under the definition for modifier -25, CPT states: The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. So you can use the same diagnosis code for the well-visit as for the hearing test: V20.2 (routine infant or child health check).

Note: Not all state Medicaid programs pay for this test, so before you invest in this machine, you might want to check with your payers first.